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Assessment of Delays in Emergency Surgical Care and Patient Postoperative Outcomes at a Referral Hospital in Northern Rwanda

  • Surgery in Low and Middle Income Countries
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Surgical interventions are cost-effective methods to save lives and prevent disabilities. Surgical delays and access to three Bellwether procedures are key monitoring indicators for universal access to safe and affordable surgical and anesthesia care and health system performance. This study assessed the delays in receiving surgical and anesthesia care for emergency surgical patients at a district hospital in Northern Rwanda.

Methods

A questionnaire was used to survey all emergency surgical patients who presented at the hospital between May and July 2020, to assess the delays in seeking (first) and reaching (second) care. In-hospital (third) delay and patient outcomes within the first 7 days postsurgery were collected by patient file auditing. Factors associated with third delay were identified through healthcare provider in-depth interviews.

Results

A total of 106 patients were surveyed, and nine healthcare providers were interviewed. The median was less than a day for first delay, 1 day for second delay, and 16.5 h for third delay for all emergency procedures. 20% of the Bellwether procedures were performed within two hours after arriving at the hospital. Factors affecting the delays included visiting a traditional healer, district of residence, referral system, income status, as well as shortage of surgeons and specialists, surgical supplies, and operating theaters.

Conclusion

Further research to study the cause of delays within the referral system is needed. Surgical outreach, equipment, and infrastructure would help to shorten in-hospital delays. Longer-term follow-up studies on patient complications and outcomes due to delay in surgical care are needed.

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Acknowledgements

We sincerely thank Muroruhirwe Piolette and Iradukunda Alexandre for their assistance in the data collection. We are also deeply indebted to the University of Global Health Equity, for the world-class education we received and the life-changing experiences we had during our one-year Master’s program. UGHE has equipped us with the tools we need to be equity-driven, conscientious, and disruptive global health leaders.

Funding

This study received no external funding support.

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Authors and Affiliations

  1. University of Global Health Equity, Kigali, PO Box 6955, Kigali, Rwanda

    Orietta Agasaro, Georgette Munezero, Rex Wong & Abebe Bekele

  2. School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA

    Rex Wong

  3. Ruhengeri Hospital, Musanze, Rwanda

    Aimé Hirwa

Authors
  1. Orietta Agasaro
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  2. Georgette Munezero
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  3. Rex Wong
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  4. Aimé Hirwa
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  5. Abebe Bekele
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Corresponding author

Correspondence to Orietta Agasaro.

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The authors declare that they have no conflict of interest.

Human and animal rights

The study was approved by the Institutional Review Board of University of Global Health Equity (protocol number: 0100).

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Informed consent was obtained from all individual participants included in the study.

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Co-first authors: Orietta Agasaro and Georgette Munezero.

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Agasaro, O., Munezero, G., Wong, R. et al. Assessment of Delays in Emergency Surgical Care and Patient Postoperative Outcomes at a Referral Hospital in Northern Rwanda. World J Surg 45, 1678–1685 (2021). https://doi.org/10.1007/s00268-021-06013-7

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  • DOI: https://doi.org/10.1007/s00268-021-06013-7

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